Jumping to the gubernatorial contest, Democratic candidate Joe Lowe endorses one very specific policy: expand Medicaid!

A former mayor of Mission Viejo, a community of 100,000 people in southern California, Lowe is critical of the current administration’s failure to expand Medicaid, calling it “unconscionable.”

It leaves 48,000 South Dakotans without health insurance, and puts a $4 million annual burden on counties for paying indigent medical bills, he said.

Expanding Medicaid would have cost the state $1.5 million, but it would have received $274 million from the federal government over three years, he said at the Beadle County Democratic Forum on Thursday [Roger Larsen, "Lowe Would Push for Expanding Medicaid and Better Teacher Pay," Huron Plainsman, 2014.04.07].

Did you catch that part about indigent care at the county level? According to a December 14, 2013, Mitchell Daily Republic report, South Dakota's counties spent $3.3 million in the preceding year (I'm guessing FY 2013?) on caring for folks too poor to cover their medical bills (the kind of people Mike Rounds says we should not help). MDR says $2.5 million of that might have been covered by the ACA Medicaid expansion that Lowe advocates. Lowe says the Medicaid expansion would cost South Dakota $1.5 million.

Spend $1.5 million, save counties $2.5 million. Right there, without any other fiscal analysis, Medicaid expansion makes sense. It reduces the tax burden on South Dakotans by $1 million.

Why would Republicans deny counties this modest but useful bit of tax relief? They will claim that we can't count on the big federal money backing the Medicaid expansion to continue, but find me one county commissioner who will say, "Well, heck, if there's a chance we aren't going to be able to save a million bucks five years from now, there's no sense in our saving a million bucks this year."

Lowe recognizes the absurdity of that fiscal position:

Gov. Dennis Daugaard has said he doesn’t trust the promises of the federal government.

“Well then, surrender the flag, shut down the state,” Lowe said. “Over half of the state’s spendable budget is federal dollars” [Larsen, 2014.04.07].

Lowe rightly notes that expanding Medicaid is immediate tax relief for counties. Why South Dakota would leave that money on the table and burden local taxpayers with higher-than-necessary taxes is beyond me.